Paper short abstract:

This paper discusses the tension between access to TB treatment as a human right in a context of underfinanced health systems and the risk that large-scale distribution of antibiotics contributes to a transition from a treatable TB epidemic to a increasingly untreatable XDR-TB epidemic.

Paper long abstract:

New public health funding mechanisms with global reach have dramatically changed the funding mechanisms of global public health, and they have changed what is to be funded, involving a shift from prevention to medical treatment. At the same time, access to treatment - especially ARV for HIV infection - had been successfully defined as a human rights issue. In 1993, WHO declared that TB presented a global health emergency and it became the focus of a separate vertical public health program, known as DOTS (directly observed treatment - short-course). Initially funded by the World Bank, bilateral donors and governments in high prevalence countries, and subsequently by the Global Fund, DOTS was a very ambitious public health programme in terms of its requirements for infrastructure, supervision, monitoring, delivery and diagnosis. It aimed for 70% case-detection and 85% treatment success rates; these cut-off points were expected to reduce prevalence by half within a decade in omplementing countries. Despite subsequent revisions of the strategy, the impact on TB prevalence in a high-prevalence country like India was marginal, whereas the country has seen the development of a new epidemic of multi-drug resistant TB (MDRTB). This situation leaves global health policy with a difficult the tension between access to TB treatment as a human right in a context of underfinanced health systems and the risk that large-scale distribution of antibiotics over a few decades will contribute to a transition from a treatable TB epidemic to a increasingly untreatable extensively drug-resistant TB (XDRTB) epidemic.